Dr Krishna Kasaraneni: Time for a fresh look at GP premises in England

By Dr Krishna Kasaraneni on the
9 March 2018

GPs want to work in modern premises that allow primary care to soak up more of the pressure facing the NHS, says GPC executive committee member Dr Krishna Kasaraneni. Writing for GPonline, he says it's time for ministers to deliver the funding to make it happen.

Despite assurances from the government and the promise of £1bn to update general practice infrastructure and premises, the process of actually getting these funds to GPs has now slowed down to snail’s pace.

Two in three GPs told us that they support maintaining the model of GPs being able to own their surgery premises. I suspect this would have been close to nearly all GPs a generation ago.

While the bureaucracy of owning and maintaining GP premises has reached new heights in recent times, the profession still firmly supports GPs as independent contractors working from premises that help develop their practice by expanding the general practice team and providing services that patients need.

Primary care hubs

Three in four GPs also told us that they would like to work in primary care premises with other community-based staff - primary care hubs providing diagnostics and extended care in the community. What this shows is not just that there is a need for investment in GP premises to make them fit for the 21st century, but also that investing in GP premises offers a tangible solution to the pressures across the NHS.

General practice is changing, the pressures on the health service are increasing. And here is a simple solution to move care into the community and provide more services more cost effectively with general practices and local communities as the centre of care. Providing more care away from hospitals in the community will provide a break to the ‘winter pressures’ that seem to extend to the full 12 months of the year. That can only be achieved by investing in GP premises to bring them up to scratch.

Now, the elephant in the room – the exorbitant service charges that are being levied on practices who are in leased NHS premises. It beggars belief that at a time when general practice is going through a crisis of this proportion, some of the landlords feel it is reasonable to increase fees to GP practices to the tune of 400% in a matter of months.

Service charges

General practice is not a commercial entity that can simply pass on the costs to the patients. The government needs to have a long hard look at itself and decide if it wants these organisations - which it exclusively owns (like NHS Property Services and Community Health Partnerships) - to support general practice or function as commercial entities that are interested in simply balancing the books.

NHS England also needs to make up its mind about what investment and value for money is. If NHS leaders see financial return as the value they are after, they’ve missed the point completely. Having appropriate premises to serve the population should be the aim of their premises investment.

The value they need to see is the transformation of general practice and community care and that will only come about if they work to remove barriers for GPs to develop premises, truly invest in GP premises and not add more bureaucracy.

Last person standing

Possibly the single biggest issue that everyone skirts around is the issue of ‘last person standing’. Whatever the situation is and the direction of travel, unless NHS England and the department of health and social care are serious about addressing this glaring threat to the independent contractor model, we will get nowhere.

We cannot accept the current situation where GPs face personal bankruptcy due to their premises liabilities. No individual GP should be left to deal with the liabilities of GP premises in such a difficult climate when GP contractors are leaving in large numbers, when time and time again the independent contractor model is proven to be the most efficient model of delivering general practice services.

It is for the above reasons that we are calling for a wide-ranging review of GP premises to run alongside the review of GP indemnity, the QOF review and the partnership model review to make sure that we secure the future of general practice.